PalliativeSymptom controlNHS service framework
End-of-life skin cancer care
Palliative oncology · terminal cancer care · end-of-life care
End-of-life care for skin-cancer patients involves symptom-focused multidisciplinary management of advanced or terminal disease, with priorities of comfort, dignity, autonomy and supportive care for patient and family. UK NICE NG142 (end-of-life care service delivery), NICE NG31 (care in the last days of life), the Leadership Alliance for Care of the Dying Person, NHS specialist palliative-care services and Macmillan / Marie Curie frameworks provide structured guidance. Common symptoms in skin oncology: fungating wounds, pain, cancer-related fatigue, cachexia, breathlessness, anxiety / distress.
CurrentLast reviewed 18 May 2026
Principles
- Patient-centred, holistic approach.
- Multidisciplinary: oncologist, palliative care, GP, district nurse, plastic / dermatology, social work, chaplaincy.
- Anticipatory care planning:
- Document ceiling of treatment, resuscitation status (DNACPR), preferred place of care / death.
- ReSPECT process in UK.
- Lasting power of attorney (LPA), advance decision to refuse treatment (ADRT).
- Communicate with sensitivity; avoid prognosis-related anxiety; offer information per patient preference.
- Family / carer support and bereavement preparation.
UK care pathway
- Specialist Palliative Care referral when symptom-control complex / prognosis <12 months.
- Hospital-based palliative-care team for inpatient care.
- Community-based: district nursing, hospice-at-home, GP, Marie Curie.
- Hospice in-patient unit for symptom-control crises or terminal phase.
- Last days of life: NICE NG31 (2015, updated) for personalised care plan.
- After death: family bereavement support, statutory paperwork, certification.
Common symptoms and management
- Pain:
- WHO analgesic ladder.
- Strong opioids (morphine, oxycodone, fentanyl); transdermal / sublingual / SC.
- Adjuvants: gabapentin / pregabalin / amitriptyline (neuropathic), dexamethasone (nerve compression / cerebral oedema).
- Local: topical lidocaine / opioid, palliative RT.
- Fungating wounds: see separate monograph; metronidazole gel, charcoal / silver dressings, tranexamic acid for bleeding.
- Cancer-related fatigue / cachexia: separate monographs.
- Breathlessness:
- Treat reversible (effusion, anaemia, infection).
- Low-dose morphine (immediate-release).
- Benzodiazepines for anxiety-related dyspnoea.
- Oxygen for documented hypoxia (not routine).
- Nausea / vomiting: cyclizine, haloperidol, levomepromazine, metoclopramide.
- Constipation: laxatives, naloxegol / methylnaltrexone for opioid-induced.
- Delirium / agitation: haloperidol, midazolam.
- Anxiety / depression: SSRIs, benzodiazepines, psychological support.
- Pruritus: see pruritus-of-malignancy monograph.
- Terminal haemorrhage (fungating wound): pre-prescribed midazolam 10 mg + diamorphine SC; dark towels; carer education.
Last days of life
- NICE NG31 framework:
- Recognition of dying: multidisciplinary clinical judgement; physical, functional, communication signs.
- Personalised care plan.
- Anticipatory medications:
- Pain: morphine 2.5-5 mg SC PRN.
- Agitation: midazolam 2.5-5 mg SC PRN.
- Nausea: levomepromazine 2.5-6.25 mg SC PRN.
- Secretions: glycopyrronium 200 µg SC PRN.
- Continuous SC infusion (syringe driver) if symptoms persistent.
- Hydration / nutrition: individualised; balance benefit vs burden.
- Communication with family; allow visiting; spiritual / religious support.
- Withdraw non-essential medications; rationalise polypharmacy.
- Death certification, MCCD, registration; bereavement support; hospice charity referral.
References
- NICE NG142. End of life care for adults: service delivery. London: NICE; 2019.
- NICE NG31. Care of dying adults in the last days of life. London: NICE; 2015 (updated).
- Leadership Alliance for the Care of Dying People. One chance to get it right. London: DH; 2014.
- British Association of Dermatologists. Dermatological palliative care guidance. London: BAD; 2023.
- Macmillan Cancer Support. End of life care guidance. London: Macmillan; 2024.
- Marie Curie. Palliative care framework. London: Marie Curie; 2024.
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